The role of vision-related problems in fatal road accidents in Finland.

PURPOSE: To evaluate the significance of vision-related problems in fatal motor vehicle accidents (FMVAs) based on a systematic investigation process by multidisciplinary road accident investigation teams (RAITs). METHODS: Retrospective registry-based study of all FMVAs during the years 2012-2016 in Finland in which driver causing the accident had a valid Finnish driving licence and the operated motor vehicle required having a driving licence. RESULTS: There were a total of 968 FMVAs. In only 1.3% of all the accidents, a vision-related problem was considered to have contributed to the FMVA, while an observational failure of 23.6% was the leading cause of all the FMVAs. CONCLUSIONS: Eye-originating vision problems are rarely a causative risk for FMVAs in Finland. Making current visual standards more stringent would unlikely to be effective in FMVA prevention.

Evaluation of the benefits of vehicle safety technology: the MUNDS study.

Real-world retrospective evaluation of the safety benefits of new integrated safety technologies is hampered by the lack of sufficient data to assess early reliable benefits. This MUNDS study set out to examine if a "prospective" case-control meta-analysis had the potential to provide more rapid and rigorous analyses of vehicle and infrastructure safety improvements. To examine the validity of the approach, an analysis of the effectiveness of ESC using a consistent analytic strategy across 6 European and Australasian databases was undertaken. It was hypothesised that the approach would be valid if the results of the MUNDS analysis were consistent with those published earlier (this would confirm the suitability of the MUNDS approach). The findings confirm the hypothesis and also found stronger and more robust findings across the range of crash-types, road conditions, vehicle sizes and speed zones than previous. The study recommends that while a number of limitations were identified with the findings that need be addressed in future research, the MUNDS approach nevertheless should be adopted widely for the benefit of all vehicle occupants.

Sudden death at the wheel due to a disease attack.

PURPOSE: To (1) examine the prevalence of fatal disease attacks while driving, (2) evaluate the potential risk of a driver's acute incapacity to drive, (3) compare the risks related to the driver's incapacity to drive with other major risks related to fatal motor vehicle accidents (fMVAs), and (4) assess how these accidents are reported in official statistics. METHODS: The data consist of information from the Finnish Road Accident Investigation Teams (RAITs) on fMVAs in Finland during 2008-2009, in-depth analyses of accidents in the Uusimaa district in 2008-2009, and data from Statistics of Finland (StatFi) concerning accidents in the Uusimaa district. RESULTS: In 2008-2009 as a whole, 488 fMVAs were encountered in Finland, and 73 of these were in Uusimaa. From fMVAs of the whole country, 55 driver deaths (11%) were due to a disease attack and in 27 (6%) of the cases, the driver was presumed to have fallen asleep. In Uusimaa approximately 25 percent (N = 18/73) of deaths at the wheel were caused by a driver's acute disease attack, but only 20 percent were recorded in the official StatFi. Cardiac and neurological diseases were the most common causes of disease attacks while driving. Additionally, disease attacks contributed as a background reason in at least 6/73 (8%) fMVAs. Speeding was found to be involved in approximately 1/3 (N = 190) of all fMVAs; however, in the absence of other risk factors, it was relatively rare (9%; N = 43). CONCLUSION: A disease attack while driving is a relatively common cause of death on the road. Severe injuries may mask the role of an initial disease attack. This hypothesis is supported by the data collected on sleeping and background accidents. Thus, the drivers' disease attacks might have an even broader impact than initially assumed. Monitoring driver health and recognizing comorbidity problems could play a large role in the promotion of road safety. The current method of monitoring the fitness to drive and producing accident statistics should be reevaluated.

[The driver's illness as a cause of traffic accidents]. / Kuljettajan sairaus kuolonkolarien aiheuttajana.

Fatal motor vehicle accidents (fMVAs) as well as accidents involving pedestrians or bicyclists in Uusimaa county in 2008 were reviewed. Of the fMVAs, acute disease attacks while driving caused 26.5% (9/34) of the drivers' deaths. This equalled with the number of alcohol-related fatal accidents. Heart attack was the main cause (7/9 disease attacks). Three bicyclists (3/14; 21%) died for health reasons; two for ventricular fibrillation and one for alcohol intoxication probably combined with cardiac arrhythmia. Diseases served also as background causes for fMVAs. Education of health care personnel on medical conditions and driving should be improved.

Observational failures/distraction and disease attack/incapacity as cause(s) of fatal road crashes in Finland.

OBJECTIVE: To study the incidence of health-related conditions and observational failures/distraction (OFD) as an immediate cause for fatal motor vehicle accidents (FMVA) and to correlate them with driver's age. METHODS: Retrospective study of all FMVA in Finland secondary to OFD from January 1995 to December 2005 and FMVA secondary to a disease attack/incapacity (DA) from January 2003 to December 2004. The data were based on the final investigation reports of the Finnish Motor Insurers' Centre. The cases were categorized into the three following groups: 1) vehicle crashes due to OFD of the driver, 2) pedestrian-vehicle accidents due to the driver's OFD, and 3) pedestrian-vehicle accidents due to the pedestrian's OFD. In the second part, 54 autopsy reports from FMVA resulting from a DA of the driver between the years 2003-2004 were revisited and the health-related causes of the accident were investigated. RESULTS: Oldest age group (> 65 years) had the highest prevalence of FMVA secondary to an OFD. We estimated that in 20-30% of all FMVA affecting subjects > 65 years an impairment of cognitive functions might have played a role. Analysis of the DA that the inspection teams had concluded to have been the immediate risk factor for the FMVA revealed that these accidents accounted for 10.3% of all FMVA in 2003-2004. Cardiovascular diseases were most often involved. CONCLUSIONS: OFD as an immediate cause of FMVA began to play a role from the age of 60 years onwards. The role of health conditions as a cause of FMVA was higher than expected. Cardiovascular disease (70%) was found to be the leading medical condition that inhibited the driving task among the DA related to FMVA in Finland.